Provider Demographics
NPI:1720210586
Name:ICC HEALTHCARE LLC
Entity Type:Organization
Organization Name:ICC HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-997-0821
Mailing Address - Street 1:1875 NW CORPORATE BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-997-0821
Mailing Address - Fax:561-997-0849
Practice Address - Street 1:1875 NW CORPORATE BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8542
Practice Address - Country:US
Practice Address - Phone:561-997-0821
Practice Address - Fax:561-997-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty